State HIX Options 'Ironic from Both Sides'

In one of the many ironies of the healthcare reform debate, several governors are citing the defense of state sovereignty as a reason why they won't build health insurance exchanges. It is a strategy that effectively cedes regulatory control of the exchanges to the federal government.

"It is ironic from both sides," says Alan Weil, executive director of the nonprofit, nonpartisan National Academy for State Health Policy. "The House Democrats wanted a national exchange and they are going to get their national exchange in the states that are generally most resistant to federal control. It is not how anyone would have planned."

The Republican governors of Texas, Kansas, Virginia, Georgia, South Carolina, and Florida have announced over the last several months that they have no intention of submitting plans for a state-run health insurance exchange under the Patient Protection and Affordable Care Act. Under the law, if states don't build the exchanges, the federal government will step in and do it.